In June 1965, with Medicare on the verge of passage, the American Medical Association had its annual convention in New York City. Twenty-five thousand organization members descended on the vast Coliseum at Columbus Circle (now site of the Time Warner Center) to take part in the five-day gathering. To the lay observer it appeared to be an impressive show of strength and unity for organized medicine.

The four-story drug and medical equipment exhibit area resembled a “supermarket of medical products.” Attendees strolled around it carrying “shopping bags crammed with pamphlets, boxes and bars of soap, weight-reducing tablets and assorted pills, tubes and bottles,” according to the New York Times. Salesmen stood in colorful booths and hawked items with titles like “Help Build Up Run-Down Patients” and “Hear New Facts About the Night Eating Syndrome.” At one display, a male model lay on a hospital bed, comfortably reading a copy of Playboy, to promote a new product designed to eliminate bedsores.

Doctors gathered in side rooms where they listened to hundreds of scholarly presentations and discussed topics ranging from the latest advances in medicine to the latest advances in quackery. In one panel, the medical director of the Food and Drug Administration gave a lecture on the addictive properties of newly discovered drugs like amphetamines and barbiturates, warning of illegal sales by “vice and crime syndicates.” In another colloquium, a psychiatrist worried that an evil, Svengali-like individual would attempt to hypnotize the public en masse through television. He assured attendees that there was a “compelling need” to institute “stringent safeguards and control” over personnel in the broadcast industry.

Among the most serious problems was tension over racial integration within the profession. A daily picket line of 150 physicians marched at the Coliseum to protest the association’s southern affiliates’ discriminatory policies against African American doctors. An AMA spokesperson unconvincingly explained at a press conference that the organization had urged its member societies “to completely get rid of discrimination,” but in view of existing civil rights laws, it “could not order them to do so.”

But despite everything happening in and around the Coliseum, the real center of activity for the profession was located six blocks south at the recently completed 50-story Americana Hotel (now the Sheraton New York at Seventh Avenue and 53rd Street). Outside the building, 1,000 members of the Congress of Senior Citizens of Greater New York stood chanting, “2-4-6-8, AMA Cooperate—Pass Medicare.” Inside the hotel’s ballroom, the association’s 235-member House of Delegates, its central decision-making body, met in closed session to discuss the impending Medicare threat.

Almost all the delegates opposed the program. “American people have the most serious misgivings about welfare statism,” an Iowa surgeon told journalists in explanation of his viewpoint. While some cautious delegates suggested that, given Medicare’s likely passage, conciliation would be wise, the majority of attendees preferred options like a boycott of the government program or a nationwide doctors’ strike. One physician even had the temerity to suggest that “force must be used when reason will not prevail.”

The delegates had a difficult choice to make. They could either accept that the government had outmuscled them, or they could double-down on their opposition and shift from politicking to insurgency. The future of organized medicine hung in the balance, and the leadership looked to one man: James Appel, the AMA’s recently elected president.